摘要
背景 冠状动脉微血管疾病(CMVD)的诊疗一直是非冠状动脉阻塞性缺血性心脏病的重点。腺苷注射液和ATP注射液是目前测定冠状动脉血流储备(CFR)评估CMVD的临床常用负荷药物,两者有所关联,但具有显著区别。ATP是腺苷的前体,其价格低廉且血管扩张机制与腺苷类似,临床上常代替腺苷,但忽视了其潜在的不良反应。目的 比较腺苷负荷与ATP负荷在评估CMVD过程中的不良反应发生率。方法 选取2019年6月—2020年7月因典型心绞痛就诊于陕西省人民医院心内科行冠状动脉造影术/冠状动脉CT血管造影术(CTA)明确各支冠状动脉残余狭窄直径<50%的患者170例,依据随机数字表法分为腺苷组和ATP组,腺苷组88例,ATP组82例。腺苷组给予腺苷注射液负荷测定CFR,ATP组采用ATP负荷测定CFR,检测过程中记录患者的血压、心率、扫描时间及不良反应发生情况。结果 与腺苷组相比,ATP组患者胸闷[61.0%(50/82)和20.4%(18/88)]、头晕[72.0%(59/82)和31.8%(28/88)]、头痛[68.3%(56/82)和11.4%(10/88)]、胃肠道不适[13.4%(11/82)和4.5%(4/88)]、心悸[69.5%(57/82)和5.7%(5/88)]、气促[40.2%(33/82)和2.3%(2/88)]、大汗[28.0%(23/82)和3.4%(3/88)]、潮热[19.5%(16/82)和2.3%(2/88)]、颜面潮红[13.4%(11/82)和4.5%(4/88)]的发生率均较高(P<0.05);两组患者神经过敏、耳鸣、咽干、颈部不适的不良反应发生率比较,差异无统计学意义(P>0.05)。结论 与ATP负荷相比,腺苷负荷测定CFR的不良反应发生率更低。
Background The treatment of coronary microvascular disease(CMVD) has always been the focus of non-coronary obstructive ischemic heart disease.Adenosine injection and adenosine disodium triphosphate(ATP) injection,which are common clinical loading drugs to determine coronary flow reserve(CFR) and evaluate CMVD,are related but significantly different.ATP is the precursor of adenosine,with low price and similar vasodilatory mechanism to adenosine,and is often substituted for adenosine in clinical practice,but its potential adverse effects are ignored.Objective To compare the incidence of adverse reactions in the assessment of coronary microvascular disease by adenosine load and adenosine disodium triphosphate load.Methods A total of 170 patients who visited the Department of Cardiology of Shaanxi Provincial People's Hospital for typical angina pectoris and underwent coronarography/Coronary CT angiography(CTA) to determine the residual stenosis diameter of each branch coronary artery <50% during June 2019 to July 2020 were selected and divided into the adenosine group(n=88) and ATP group(n=82) based on random number table method.CFR was determined by adenosine injection loading in the adenosine group and by ATP loading in the ATP group.Blood pressure,heart rate,scanning time and adverse reactions of patients were recorded during the detection process.Results The incidence of adverse reactions of chest tightness[61.0%(50/82)vs 20.4%(18/88)],dizziness[72.0%(59/82) vs 31.8%(28/88)],headache[68.3%(56/82) vs 11.4%(10/88)],gastrointestinal discomfort[13.4%(11/82) vs 4.5%(4/88)],palpitation[69.5%(57/82) vs 5.7%(5/88)],shortness of breath[40.2%(33/82) vs 2.3%(2/88)],profuse sweating[28.0%(23/82) vs 3.4%(3/88)],hot flush [19.5%(16/82) vs 2.3%(2/88)]and facial flushing[13.4%(11/82) vs 4.5%(4/88)] in patients in the ATP group were higher than those in the adenosine group(P<0.05).There was no significant difference in the incidence of neuroticism,tinnitus,dry throat and neck discomfort between the two groups(P>0.05).Conclusion C
作者
赵慧
李文豪
程功
陈亮
梁宸源
王依阳
蒋红英
姜瑞嘉
ZHAO Hui;LI Wenhao;CHENG Gong;CHEN Liang;LIANG Chenyuan;WANG Yiyang;JIANG Hongying;JIANG Ruijia(Department of Cardiology,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Interventional Catheterization Laboratory,Shaanxi Provincial People's Hospital,Xi'an 710068,China)
出处
《中国全科医学》
CAS
北大核心
2024年第17期2109-2112,共4页
Chinese General Practice
基金
陕西省自然科学基础研究计划(2022JQ-891)
陕西省中医药管理局项目(2021-ZZ-ZY003)
陕西省人民医院科技创新领军人才项目(2022LJ-04)。
